Fiegen, Anthony P.

Abstract The medial collateral ligament serves as the primary stabilizer to valgus stress on the medial side of the knee and is the most commonly injured ligament in the knee. Medial collateral ligament reconstruction can provide improved stability and clinical outcomes for patients. Advancements in techniques, including the use of an adjustable‐length‐loop suspensory fixation device through a longitudinal incision, have been introduced in recent years. The purpose of this Technical Note and video is to provide a minimally invasive method for medial collateral ligament reconstruction with adjustable‐loop femoral fixation and posteromedial corner plication. Technique Video video See video under supplementary data.

Objectives: Baseball pitchers often participate in throwing programs that involve throwing at reduced effort levels to gradually increase the amount of stress experienced across the elbow. It is currently unknown how reduced effort pitching compares to maximum effort with respect to elbow stress and ball velocity. The purpose of this study is to determine whether elbow stress and ball velocity correlate with reduced effort pitching, whether elbow stress and ball velocity decrease proportionally while throwing at a reduced effort, and to assess intrathrower reliability. Methods: Ten healthy male high school baseball pitchers threw 5 pitches from a regulation pitching mound at 3 effort levels: maximum effort, 75% effort, and 50% effort. Elbow stress, specifically elbow varus torque, was calculated for all pitches using a marker-based 3D motion capture system. Ball velocity was measured using a Doppler radar gun. Intrathrower variability was calculated for each effort level. Results: Elbow stress and ball velocity decreased with reduced effort throws (p<0.001 and p=0.003, respectively). However, the reductions in elbow stress and ball velocity were not proportional. At 75% effort throws, elbow stress decreased only 19% and ball velocity decreased only 10%. At 50% effort throws, elbow stress decreased only 25% and ball velocity decreased only 15%. Intrathrower reliability was excellent for elbow stress and ball velocity, with intraclass correlation coefficients all greater than or equal to 0.80. Conclusions: Pitching at a reduced effort level resulted in decreased elbow stress and ball velocity. However, for every 25% reduction in perceived effort, elbow stress decreased by a mean of 13% and ball velocity decreased 8%. When baseball pitchers attempt to throw at a reduced effort of maximum, throwing metrics do not decrease proportionately. While pitching at a reduced effort of maximum decreases elbow stress and ball velocity, the decrease is not proportional, subjecting the elbow to more stress than intended. This has significant clinical importance to pitchers, coaches, and medical professionals in the setting of injury prevention and return to sport. [Table: see text]

Background: Baseball pitchers often participate in throwing programs that involve throwing at reduced effort levels to gradually increase the amount of stress experienced across the elbow. It is currently unknown how reduced effort pitching compares with maximum effort with respect to elbow stress and ball velocity. Purpose/Hypothesis: The purpose was to determine the correlation between elbow stress and ball velocity with reduced effort pitching. We hypothesized that decreased perceived effort would disproportionately correlate with elbow stress and ball velocity. Study Design: Descriptive laboratory study. Methods: Ten healthy male high school baseball pitchers threw 5 pitches from a regulation pitching mound at 3 effort levels: maximum effort, 75% effort, and 50% effort. Elbow stress, specifically elbow varus torque, was calculated for all pitches using a validated marker-based 3-dimensional motion capture system. Ball velocity was measured using a Doppler radar gun. Intrathrower variability was calculated for each effort level. Results: Elbow stress and ball velocity decreased with reduced effort throws ( P < .001 and P = .003, respectively). However, the reductions in elbow stress and ball velocity were not proportional. At 75% effort throws, elbow stress measured 81% (intraclass correlation coefficient [ICC], 0.95), and ball velocity measured 90% (ICC, 0.80) of maximum, respectively. At 50% effort throws, elbow stress measured 75% (ICC, 0.93), and ball velocity measured 85% (ICC, 0.87) of maximum. Intrathrower reliability was excellent for elbow stress and ball velocity, with all ICCs ≥0.80. Conclusion: Pitching at a reduced effort level resulted in decreased elbow stress and ball velocity. However, for every 25% reduction in perceived effort, elbow stress decreased by a mean 13%, and ball velocity decreased 7.5%. When baseball pitchers attempt to throw at a reduced effort of maximum, throwing metrics do not decrease proportionately. Clinical Relevance: While pitching at a reduced effort of maximum decreases elbow stress and ball velocity, the decrease is not proportional, subjecting the elbow to more stress than intended. This has significant clinical importance to pitchers, coaches, and medical professionals in the setting of injury prevention and return to sports.

Background: In recent years, the prevalence of medial ulnar collateral ligament injuries has increased in throwers of all ages and skill levels. The motusBASEBALL sensor possesses an inertial measurement unit (IMU) that has been developed and applied to the throwing arm to allow for measurements of several objective parameters, which may prove beneficial for monitoring, rehabilitation, and injury prevention in the throwing athlete. However, the reliability, consistency, and validity of the IMU have not been independently assessed. Purpose: To evaluate the reliability, consistency, and validity of the motusBASEBALL sensor compared with the historic gold standard of marker-based motion capture. Study Design: Controlled laboratory study. Methods: A total of 10 healthy male baseball athletes with varsity-level high school experience volunteered to participate in this study. Participants were fitted with 37 retroreflective markers for motion capture and the motusBASEBALL IMU sensor. Participants threw 5 fastballs at maximum effort, with measurements recorded simultaneously by motion capture and the IMU. Arm slot, arm speed, arm stress, and shoulder rotation were measured and compared. Results: Of the 4 metrics generated by the IMU, significant differences were found for 3 of the throwing metrics compared with motion capture including arm slot (5.0°± 6.1°; P = .037), elbow varus torque (9.4 ± 12.0 N·m; P = .037), and shoulder rotation (6.3°± 6.1°; P = .014). Arm speed did not demonstrate a statistically significant difference (29.2 ± 96.8 rpm; P = .375). The IMU consistently underreported pitching performance values. Shoulder rotation exhibited excellent reliability with <5° of error, and arm slot demonstrated good reliability with <10° of error. Arm stress and arm speed were less reliable. Conclusion: The IMU was not accurate or valid for arm slot, arm stress, and shoulder rotation compared with marker-based motion capture. It was relatively accurate for arm speed. Despite its lack of validity, it was consistent and reliable for arm speed and shoulder rotation and relatively reliable for arm slot and arm stress. Caution should be used when comparing values provided by this IMU to the gold standard of marker-based motion capture. Clinical Relevance: IMU technology has potential to be used in monitoring, rehabilitation, and injury prevention in throwing athletes if valid. This study demonstrates that the values provided by the IMU should not be considered equivalent to those generated by the gold standard of marker-based motion capture; however, there may still be a role for this technology when relying on its internal consistency for intrathrower comparisons and tracking.

Objective To report radiographic and magnetic resonance imaging findings, patient-reported outcomes, and complications and/or reoperations following nonarthroplasty surgical intervention for focal glenohumeral cartilage defects. Design A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they possessed a chondral defect of the humeral head, glenoid, or both, which had been treated with a joint preserving nonarthroplasty procedure. Risk of bias assessment was performed using the Methodological Index for Non-Randomized Studies scoring system. Study demographics, surgical technique, imaging findings, patient-reported outcomes, complications, failures, and reoperations were collected. Results Fourteen studies with 98 patients (100 shoulders) met the inclusion criteria. Patient ages ranged from 7 to 74 years. The nonarthroplasty surgical techniques utilized included microfracture (67 shoulders), osteochondral transplantation (28 shoulders), chondrocyte transplantation (4 shoulders), and internal fixation (1 shoulder). The rates of radiographic union and progression of osteoarthritis ranged between 90% to 100% and 57% to 100%, respectively. Visual analog scores ranged from 0 to 1.9 at final follow-up. Mean postoperative ASES (American Shoulder and Elbow Surgeons) shoulder scores ranged from 75.8-100. Mean postoperative CSS (Constant Shoulder Score) scores ranged from 83.3-94. Mean postoperative SSV (Subjective Shoulder Value) ranged from 70% to 99%. Failure and reoperation rates ranged between 0% to 35% and 0% to 30%, respectively, with the most common reoperation being conversion to prosthetic arthroplasty. Conclusions In this systematic review, nonarthroplasty surgical techniques demonstrated acceptable rates of radiographic healing, improved patient reported outcomes, minimal complications, and low rates of failure or reoperation. Joint preserving techniques are likely viable options to prolong function of the native shoulder and provide short- to midterm pain relief in young and highly active patients. Level of Evidence Level IV.